Objective: Donors’ health and safety are mandatory in the living-donor kidney transplantation procedure. Laparoscopic live donor nephrectomy (LLDN) provides an increase in donor numbers with its benefits and becomes a standard of care. We aimed to explain the results, complication rates, tips, and tricks of the largest number of LLDN case series ever performed in the literature. Materials and Methods: Between August 2012 and December 2019, 2,477 live donor case files were analyzed retrospectively. Age, gender, hospitalization times, body mass index, warm ischemia times, operation times, numbers of arteries, side of the kidneys, and complications were noted. Results: 1,421 (57.4%) of 2,477 donors were female (p = 0.007). Operation times and warm ischemia times were found longer in right-sided LLDN and donors with multiple renal arteries (p = 0.046, <0.001, and <0.001, respectively). Obesity (BMI >30 kg/m2) did not affect warm ischemia times while prolonging the operation times (p = 0.013). Hospitalization times and numbers of complications were higher in obese donors. Conclusions: LLDN seems to be a reliable solution with fewer complications and higher satisfaction rates. We hope to illuminate the way with tips and trick points for beginner transplant surgeons based on the experience obtained from 2,477 LLDN cases.

1.
Sarier
M
,
Demir
M
,
Goktas
S
,
Duman
I
,
Buyukkinaci
M
,
Yuksel
Y
, et al.
Results of real-time multiplex polymerase chain reaction assay in renal transplant recipients with sterile pyuria
.
Transplant Proc
.
2017 Aug
;
49
(
6
):
1307
11
. .
2.
Ratner
LE
,
Ciseck
LJ
,
Moore
RG
,
Cigarroa
FG
,
Kaufman
HS
,
Kavoussi
LR
.
Laparoscopic live donor nephrectomy
.
Transplantation
.
1995 Nov 15
;
60
(
9
):
1047
9
..
3.
Shafizadeh
S
,
McEvoy
JR
,
Murray
C
,
Baillie
GM
,
Ashcraft
E
,
Sill
T
, et al.
Laparoscopic donor nephrectomy: impact on an established renal transplant program
.
Am Surg
.
2000 Dec
;
66
(
12
):
1132
5
..
4.
Power
RE
,
Preston
JM
,
Griffin
A
,
Martin
I
,
Wall
DR
,
Nicol
DL
.
Laparoscopic vs open living donor nephrectomy: a contemporary series from one centre
.
BJU Int
.
2006 Jul
;
98
(
1
):
133
6
. .
5.
Afaneh
C
,
Aull
MJ
,
Gimenez
E
,
Wang
G
,
Charlton
M
,
Leeser
DB
, et al.
Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes
.
Urology
.
2011 Dec
;
78
(
6
):
1332
7
. .
6.
Nanidis
TG
,
Antcliffe
D
,
Kokkinos
C
,
Borysiewicz
CA
,
Darzi
AW
,
Tekkis
PP
, et al.
Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis
.
Ann Surg
.
2008 Jan
;
247
(
1
):
58
70
. .
7.
Fuller
TF
,
Deger
S
,
Büchler
A
,
Roigas
J
,
Schönberger
B
,
Schnorr
D
, et al.
Ureteral complications in the renal transplant recipient after laparoscopic living donor nephrectomy
.
Eur Urol
.
2006 Sep
;
50
(
3
):
535
1
.
discussion 540–1
. .
8.
Ng
ZQ
,
He
B
.
A proposed classification system and therapeutic strategy for chyle leak after laparoscopic living-donor nephrectomy: a single-center experience and review of the literature
.
Exp Clin Transplant
.
2018 Apr
;
16
(
2
):
143
9
.
9.
Hasson
HM
.
A modified instrument and method for laparoscopy
.
Am J Obstet Gynecol
.
1971 Jul 15
;
110
(
6
):
886
7
. .
10.
Sarier
M
,
Callioglu
M
,
Yuksel
Y
,
Duman
E
,
Emek
M
,
Usta
SS
.
Evaluation of the renal arteries of 2,144 living kidney donors using computed tomography angiography and comparison with intraoperative findings
.
Urol Int
.
2020
;
104
(
7–8
):
637
. .
11.
Yuksel
Y
.
Comparison of experienced centers with inexperienced centers in cadaveric organ preparation for transplantation
.
Ann Med Res
.
2019
:
1
. .
12.
Guidelines for Living Donor Kidney Transplantation. Br Transplant Soc [Internet]. 2018 Mar [cited 2020 May 18]. Available from:
https://bts.org.uk/wp-content/uploads/2018/07/FINAL_LDKT-guidelines_June-2018.pdf.
13.
Sawinski
D
,
Locke
JE
.
Evaluation of kidney donors: core curriculum 2018
.
Am J Kidney Dis
.
2018 May 1
;
71
(
5
):
737
47
. .
14.
Boentoro
S
,
Wahyudi
I
,
Mochtar
CA
,
Hamid
ARA
.
Blood transfusions in laparoscopic living donor nephrectomy: single center experience from 500 cases
.
Res Rep Urol
.
2020
;
12
:
1
. .
15.
Mohsin
R
,
Shehzad
A
,
Bajracharya
U
,
Ali
B
,
Aziz
T
,
Mubarak
M
, et al.
Laparoscopic donor nephrectomy: early experience at a single center in Pakistan
.
Exp Clin Transplant
.
2018 Apr
;
16
(
2
):
138
42
.
16.
Cho
SJ
,
Moon
HW
,
Kang
SM
,
Choi
SW
,
Kim
KS
,
Choi
YS
, et al.
Evolution of laparoscopic donor nephrectomy techniques and outcomes: a single-center experience with more than 1,000 cases
.
Ann Transplant
.
2020 Feb 11
;
25
:
e918189
.
e918189-1-e918189-9
. .
17.
Wiborg
MH
,
Toft
A
,
Jahn
H
,
Hansen
LU
,
Lund
L
.
Initial experience with hand-assisted laparoscopic donor nephrectomy: a single-centre experience over 5 years
.
Scand J Urol
.
2017 Feb
;
51
(
1
):
73
7
. .
18.
Abdellaoui
I
,
Azzabi
A
,
Sahtout
W
,
Sabri
F
,
Hmida
W
,
Achour
A
.
Short- and long-term follow-up of living kidney donors
.
Saudi J Kidney Dis Transpl
.
2019 Apr
;
30
(
2
):
401
20
.
19.
Unger
LW
,
Feka
J
,
Sabler
P
,
Rasoul-Rockenschaub
S
,
Györi
G
,
Hofmann
M
, et al.
High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors – Retrospective analysis of 289 consecutive cases
.
Int J Surg
.
2017 Oct
;
46
:
172
7
. .
20.
Raber
B
,
Westmoreland
M
,
Arnold
D
,
Derek
B
,
Lueking
R
,
Lassiter
G
, et al.
Laparoscopic donor nephrectomy: a single institution minimally invasive general surgeon experience 1999–2013
.
Am J Surg
.
2017 Dec 1
;
214
(
6
):
1220
5
.
21.
Takagi
K
,
Kimenai
HJAN
,
IJzermans
JNM
,
Minnee
RC
.
Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy
.
Surg Endosc
.
2020 Nov
;
34
(
11
):
4901
8
.
22.
Marcelino
A
,
Mochtar
CA
,
Wahyudi
I
,
Hamid
AR
.
Obese Kidney Donors in the Laparoscopic Living Nephrectomy Era: How Safe?
Ann Transplant
.
2016 May 10
;
21
:
297
300
.
23.
Schussler
L
,
Khetan
P
,
Peacock
M
,
Dickstein
E
,
LaPointe-Rudow
D
,
Palese
M
, et al.
Is obesity a contraindication for kidney donation?
Surg Endosc
.
2020
;
34
(
10
):
4632
7
.
24.
Aalami
OO
,
Allen
DB
,
Organ
CH
.
Chylous ascites: a collective review
.
Surgery
.
2000 Nov
;
128
(
5
):
761
78
. .
25.
Seth
A
,
Sharma
A
,
Kenwar
DB
,
Singh
S
.
Chylous ascites: complication of laparoscopic donor nephrectomy. Case report and review of literature
.
Transplantation
.
2019
;
103
(
4
):
e74
8
. .
26.
Qiu
Y
,
Song
TR
,
Rao
ZS
,
Wang
XD
,
Huang
ZL
,
Lin
T
.
[Learning curve of retroperitoneal laparoscopic donor nephrectomy and risk analysis of intraoperative complications]
.
Sichuan Da Xue Xue Bao Yi Xue Ban
.
2016 Jul
;
47
(
4
):
547
50
.
27.
Kumar
A
,
Chaturvedi
S
,
Gulia
A
,
Maheshwari
R
,
Dassi
V
,
Desai
P
.
Laparoscopic live donor nephrectomy: comparison of outcomes right versus left
.
Transplant Proc
.
2018 Oct 1
;
50
(
8
):
2327
32
. .
28.
Pandarinath
SR
,
Choudhary
B
,
Chouhan
HS
,
Rudramani
S
,
Dubey
D
.
Transperitoneal laparoscopic left versus right live donor nephrectomy: comparison of outcomes
.
Indian J Urol
.
2014
;
30
(
3
):
256
60
. .
29.
Qiu
Y
,
Wang
X
,
Song
T
,
Rao
Z
,
Liu
J
,
Huang
Z
, et al.
Comparison of both sides for retroperitoneal laparoscopic donor nephrectomy: experience from a single center in China
.
Transplant Proc
.
2017 Jul 1
;
49
(
6
):
1244
8
. .
30.
Hellegering
J
,
Visser
J
,
Kloke
HJ
,
D’Ancona
FC
,
Hoitsma
AJ
,
van der Vliet
JA
, et al.
Deleterious influence of prolonged warm ischemia in living donor kidney transplantation
.
Transplant Proc
.
2012 Jun 1
;
44
(
5
):
1222
6
. .
31.
Heylen
L
,
Naesens
M
,
Jochmans
I
,
Monbaliu
D
,
Lerut
E
,
Claes
K
, et al.
The effect of anastomosis time on outcome in recipients of kidneys donated after brain death: a cohort study
.
Am J Transplant
.
2015
;
15
(
11
):
2900
7
. .
32.
Özdemir-van Brunschot
DMD
,
Koning
GG
,
van Laarhoven
KCJHM
,
Ergün
M
,
van Horne
SBCE
,
Rovers
MM
, et al.
A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis
.
PLoS One
.
2015 Mar 27
;
10
(
3
):
e0121131
.
33.
Wang
K
,
Zhang
P
,
Xu
X
,
Fan
M
.
Right versus left laparoscopic living-donor nephrectomy: a meta-analysis
.
Exp Clin Transplant
.
2015 Jun
;
13
(
3
):
214
26
.
34.
Al-Oraifi
I
,
Tawfeeq
M
,
Al-Hellow
H
,
Al-Qahtani
MS
,
Al-Bugami
MM
,
Al-Shahrani
A
, et al.
Laparoscopic donor nephrectomy of dual renal artery kidneys: single center experience
.
Chirurgia
.
2017 Apr
;
112
(
2
):
124
9
. .
35.
Bandín Musa
AR
,
Montes de Oca
J
.
Hand-assisted laparoscopic nephrectomy in living-donor kidneys with multiple arteries: experience of a transplant center
.
Exp Clin Transplant
.
2016 Apr
;
14
(
2
):
153
6
.
36.
Yuksel
Y
.
Üreter Dubplikasyonlu Greft Böbreklerde Nakil Tecrübemiz
.
SDÜ Tıp Fakültesi Derg
.
2019 Jun 1
;
26
(
2
):
195
200
.
37.
Buell
JF
,
Hanaway
MJ
,
Woodle
ES
.
Maximizing renal artery length in right laparoscopic donor nephrectomy by retrocaval exposure of the aortorenal junction
.
Transplantation
.
2003 Jan
;
75
(
1
):
83
5
. .
38.
Liu
Y
,
Huang
Z
,
Chen
Y
,
Liao
B
,
Luo
D
,
Gao
X
, et al.
Staplers or clips?
Medicine
.
2018 Nov 9
;
97
(
45
):
e13116
.
39.
McGregor
TB
,
Patel
P
,
Sener
A
,
Chan
G
.
Vascular control during laparoscopic kidney donation
.
Can J Surg
.
2017 Jun
;
60
(
3
):
150
1
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.